Tuesday, February 19, 2013

Healing Bone Fractures, Part 2 of 5

This is the second in a series of posts in which I am documenting the process of treating a serious fracture of my right leg. In Part 1 I discussed the details behind the injury and the initial protocols that I used with the remedies I had available while I was still away. In this post I am going to explain the protocol that I implemented when I returned home.

I returned home on evening of Sunday February 3rd, four days after my injury and three days after my surgery. On Monday we picked up some additional supplements that I needed and then on Tuesday I made up a couple of new formulations specifically formulated to address my injury. This is the protocol that I implemented at that time:

Homeopathics: I am taking Arnica 200C, Hypericum 200C and Symphytum 200C individually, four pellets per dose alternated throughout the day. The dosage of each remedy varies over time according to the following protocol:
  • Week 1: Arnica 4 doses per day; Hypericum 4 doses per day; Symphytum 4 doses per day.
  • Week 2: Arnica 3 doses per day; Hypericum 3 doses per day; Symphytum 3 doses per day.
  • Week 3: Arnica 2 doses per day; Hypericum 2 doses per day; Symphytum 3 doses per day.
  • Week 4: Arnica 1 dose per day; Hypericum 1 dose per day; Symphytum 3 doses per day.
  • Week 5 and onwards (until my bones are completely healed): Symphytum 3 doses per day.

Herbs: I created three new formulations to address my specific needs:
  • A systemic herbal formulation prepared from 1:5 fresh herb tinctures containing turmeric rhizome (Curcuma longa) 18%, common horsetail herb (Equisetum arvense) 15%, boneset herb (Eupatorium perfoliatum) 15%, St. Johnswort herb (Hypericum perforatum) 15%, American plantain herb (Plantago rugelii) 15%, common comfrey herb (Symphytum officinale) 15%, wild ginger rhizome (Asarum canadense) 5%, white pine leaf/twig (Pinus strobus) 2%. This formulation is a specific for healing damaged tissues and blood vessels, bone, and improving general circulation. Boneset and turmeric also have a significant tonic action on the liver which will help address any stress on my liver from the medications and other aspects of my hospital experience, as well as protect my liver from any toxicity from the pyrrolizidine alkaloids in the comfrey, which is the best herb I know for healing bones and well worth the very slight risk of toxicity. Given that the comfrey will not exceed the 15-20% range in any of the formulations that I use and will be combined with herbs that can mitigate its potential toxicity, the likelihood of any toxicity is almost nil. Boneset and horsetail are also specifics for healing bone tissue. This formulation is taken in 6 ml doses three times per day on an empty stomach, 5-10 minutes before each meal.

Boneset (Eupatorium perfoliatum) is an excellent healing herb that is very effective for the healing of bone tissue.
  • A systemic herbal sleep formulation prepared from 1:5 fresh herb tinctures containing English lavender flowering spike (Lavandula angustifolia) 20%, St. Johnswort herb (Hypericum perforatum) 20%, catnip herb (Nepeta cataria) 20%, American plantain herb (Plantago rugelii) 15%, hop strobilus (Humulus lupulus) 15%, turmeric rhizome (Curcuma longa) 9%, white pine leaf/twig (Pinus strobus) 1%. The dosage of this formulation is 6 ml immediately before bed and additional 3 ml doses through the night, as required. Getting sufficient sleep is one of my greatest challenges. I tend to be a light sleeper. I sleep on my sides and wake up four or five times a night feeling a bit stiff and change my position, flipping from side to side and then falling back to sleep fairly quickly. With my broken leg I can only sleep on my back. This is difficult for me because as a general rule I can't sleep on my back, and it also doesn't allow me to shift my position sufficiently. By half way through the night my lower back is very stiff and sore. Most nights I'm only getting five to six hours sleep, and that's with the sleep formulation. Occasionally I get a bit more. Getting sufficient sleep is critical to the healing process, so I made this formulation to help me sleep better. Notice that it contains a few of the herbs that are in my daytime formulation. This is to help continue to support the healing process through the night. It is also important that the overlapping herbs contribute to the sleep formulation. You will find few, if any, references to plantain having sedative properties, but it does. As a general rule, whenever someone is taking more than one herbal formulation concurrently, it is usually preferable if there is some overlap between the herbs in the different formulations. As in this case, the overlapping herbs must contribute to the desired actions of both formulations.
  • A topical liniment made up of a base containing 1:5 fresh herb infused oils of pot marigold flower head (Calendula officinalis), Canada goldenrod leaf (Solidago canadensis), wild bergamot herb (Monarda fistulosa), coltsfoot leaf (Tussilago farfara), St. Johnswort herb (Hypericum perforatum), northern white pine leaf (Pinus strobus) and American plantain herb (Plantago rugelii). This infuse oil was prepared last year. The herbs are in descending order based on proportion as I am not certain of the exact percentages. To the base oil I added the following essential oils at an overall potency of two drops per ml of base oil: rosemary leaf (Rosmarinus officinalis) 25%, English lavender flower (Lavandula angustifolia) 25%, black spruce leaf/twig (Picea mariana) 15%, marjoram herb (Origanum majorana) 10%, eastern hemlock leaf/twig (Tsuga canadensis) 10%, Roman chamomile flower head (Chamaemelum nobile) 5%, yarrow herb (Achillea millefolium) 5% and eastern white cedar (Thuja occidentalis) 5%. I apply this twice a day, immediately upon waking and just before bed, to the lower thigh, knee and half of the foot of my injured leg as my leg below my knee and half of my foot are covered by a tensor bandage. I also apply it to the hip, knee and ankle of my left leg, and my wrists, as these areas are being stressed in unusual ways due to using crutches.

In this photograph we have common plantain (Plantago major), an alien species that has naturalized throughout
North America, on the left, and American plantain (P. rugelii), our native species, on the right. Notice the
reddish colour at the base of the petioles (leaf stalks) of American plantain. Most people
(including herbalists) don't realize that these are two different species.

Two weeks after my surgery I went to the hospital to have my stitches removed. There was a lot of pressure on my stitches due to the edema in my leg that occurs whenever I am moving around in an upright position. The blood and lymph tends to pool in my leg because I am not using my leg to walk, which is necessary to efficiently pump the fluids out of my leg against the force of gravity. As a result, the doctor decided to leave every second stitch in my lower, longer incision for another two weeks. In the mean time, beginning a couple of days after I got my stitches out I started poulticing the shorter incision from which all of the stitches were removed. I am applying a poultice twice per day for 30-45 minutes. The primary herbs that I am using are common comfrey leaf (Symphytum officinale), stinging nettle leaf (Urtica dioica), pot marigold petals (Calendula officinalis), purple loosestrife herb (Lythrum salicaria), and a bit of whole flax seed (Linum usitatissimum) to increase the mucilage content. I use these herbs in roughly equal proportions (except for the flax seed) and each time add a sixth herb in a similar proportion. I have a lot of "ends" which are small quantities of herbs that are left over from when I harvest herbs to make tinctures. I dry these remainders and use them when the opportunity arises. This is one of those opportunities. Each time I make a poultice I use a different sixth herb. Some of the herbs that I have used so far include elecampane leaf (Inula helenium), wood nettle leaf (Laportea canadensis), Canada goldenrod herb (Solidago canadensis), blueweed herb (Echium vulgare), blue vervain herb (Verbena hastata), wormwood herb (Artemisia absinthium), yarrow herb (Achillea millefolium), yellow bedstraw herb (Galium verum) and pearly everlasting herb (Anaphalis margaritacea).

Supplements: I was able to obtain the additional supplements that I need over the course of the first week that I was back so that since about a week and a half after my injury I have been on the full complement of supplements that I need to help heal my leg. These supplements are very important whenever there is significant tissue damage, but they are particularly important for healing damaged bone, cartilage, tendons and ligaments, regardless of the cause of damage. I use a similar supplement regimen for the treatment of osteoarthritis and osteoporosis. Although there are a number of supplements available that are formulated for building bone tissue that contain some of these nutrients, I chose not to use any of them because I didn't like any of the formulations. All of them were missing important nutrients, had way too much calcium relative to the other ingredients, and most of them were compromised in some way by using cheaper, low quality ingredients such as magnesium oxide. As a result, I had to put this supplement regimen together using a fair number of products. Nevertheless, the importance of using all of these nutrients in the right balance can not be over emphasized. I have listed them here by nutrient instead of by which ones I am taking with each meal, as I did in the first post of this series, so that it is more clear what I am taking. All of these are taken with meals:
  • Vitamin A: 3,500 IU with breakfast; 3,500 IU with dinner.
  • Beta-carotene: 750 IU with breakfast; 750 IU with dinner.
  • Vitamin C (calcium and magnesium ascorbate): 1,485 mg with breakfast; 1,360 mg with lunch; 1,485 mg with dinner.
  • Vitamin D: 1,200 IU with breakfast; 1,000 IU with lunch; 1,400 IU with dinner.
  • Vitamin E (mixed tocopherols, acetate): 115 IU with breakfast; 40 IU with lunch; 315 IU with dinner.
  • Vitamin K: 60 mcg with breakfast; 80 mcg with dinner.
  • Calcium (citrate, ascorbate, malate): 150 mg with breakfast; 135 mg with lunch; 450 mg with dinner.
  • Magnesium (citrate, ascorbate, malate): 60 mg with breakfast; 60 mg with lunch; 260 mg with dinner.
  • Zinc (citrate): 5 mg with breakfast; 25 mg with dinner.
  • Silicon (aqueous horsetail extract): 4.7 mg with breakfast; 4.7 mg with lunch; 4.7 mg with dinner.
  • Manganese (chelate, citrate): 0.5 mg with breakfast; 5.5 mg with dinner.
  • Copper (citrate): 0.5 mg with breakfast; 1.5 mg with dinner.
  • Boron (chelate): 350 mcg with breakfast; 350 mcg with dinner.
  • Selenium (chelate): 50 mcg with breakfast; 150 mcg with dinner.
  • Polyphenol complexes (flavonoids, anthocyanidins, proanthocyanidins and catechins from extracts of berries, citrus, grape seed and green tea): 325 mg with breakfast; 225 mg with lunch; 325 mg with dinner.
  • Quercetin: 100 mg with breakfast; 100 mg with lunch; 100 mg with dinner.
  • Lutein: 0.5 mg with breakfast; 0.5 mg with dinner.

Blueberries (Vaccinium spp.) are a very rich source of anthocyanins and flavonoids, including quercetin.

Some of these are ingredients from a multivitamin that I am taking with breakfast and dinner. It is a good quality low potency multi with an excellent trace mineral content. It does not contain iron. I did not list all of the ingredients of the multivitamin, only those that are important for bone repair. However, the full range of nutrients in the multi are important to support healing in general. Mostly what I haven't listed are the B vitamins and some of the other trace minerals. In addition, I am also taking omega-3 fatty acids in the form of organic flax seed oil, 2-3 teaspoons taken throughout the day mixed in food (but not heated).

In addition to the above supplements that I am taking with meals, I am also taking the following on an empty stomach three times per day 30 minutes before each meal:
  • Methylsulfonylmethane (MSM) 400 mg.
  • Glucosamine hydrochloride 300 mg.
  • Betaine 80 mg.
  • Hyaluronic acid 10 mg.

Probiotics: Another one of the challenges that I am dealing with is constipation. It started with fasting from food and water for 16 hours before my surgery and was further aggravated by the intravenous hydromorphone and three courses of intravenous antibiotics that I was given through the night after my surgery. However, the ongoing issue is that I am spending a lot more time sitting and can't walk or run, which is important for good bowel tone. I am addressing this by taking a high potency probiotic supplement that contains 25 billion active cells of a combination of eight active strains of bacteria. I take this first thing in the morning in a glass of warm water with a tablespoon of whole organic flax seed. My bowel movements gradually returned to normal during the first week that I took this and I am continuing to take it on an ongoing basis.

Lactobacillus rhamnosus: An important probiotic species.

Exercise: This is another of my major challenges. The surgeon wants me to spend most of my day sitting or laying with my injured leg raised. This is not an option. It's bad enough that the muscles in my right leg are getting weaker. I'm not going to sit around and let my whole body atrophy. Plus, I have clients and students that depend on me and lots of work to be done. My life has definitely slowed down and there are many things that are too difficult or impossible for me to do, but I'm not out of commission completely. I have sit stations all over my house where I work, eat and rest consisting of a padded chair to sit on and a second chair with a pillow on it that I can put my leg up on. I have found that there is a delicate balance between sitting and moving around upright. If I do either for too long, the edema in my lower right leg gets worse.

Aside from the exercise I get moving around on crutches, every morning before breakfast I do an upper body workout with light weights and lots of stretching. I'm also working my injured leg as best I can. Whenever I'm sitting for periods of time I periodically massage my thigh and knee. I also wiggle my toes a lot and gently stretch the tendons and ligaments in my ankle and knee. In addition, I'm doing my best to work out my right knee and hip as best I can without being able to walk. To maintain some level of strength in these joints I do leg lifts from my hip raising my whole leg, and from my knee raising my lower leg several times per day for a few minutes. I also "pump" my leg while I'm walking on crutches by raising my leg and bending my knee on one step and then lowering my leg on alternate steps. As before I also continue to do deep breathing exercises in which I "feel" the life force or qi energy flowing into and out of my leg.

Diet: My diet is pretty good in general. It is almost completely organic and I get a lot of variety. My only concern is getting a bit more good quality protein. I have been a vegetarian for 33 years. Contrary to what some people believe, it is very easy for vegetarians to consume sufficient protein. Nevertheless, a good supply of high quality protein is necessary to heal bone tissue. Rather than bump up some of the typical high protein vegetarian foods such as beans or nuts which are harder on the digestive system, I have decided to increase my protein somewhat by eating one or two organic, free-range eggs most days. I have to strike a balance here and not eat too many eggs because for me eggs tend to be constipating.

So there you have it! This is the regimen I am following at this time. It is very intensive. I probably spend about 10% of my waking hours engaged in some aspect of this healing protocol. However, that's not bad considering I am still working at about 60% capacity instead of laying around like the surgeon advised me to. Also, with the exception of the intravenous hydromorphone and three courses of intravenous antibiotics that I was given through the night immediately after my surgery, I did not fill the prescription for painkillers that the surgeon gave me and only had to take a single dose of acetaminophen about 24 hours after my surgery. When I had the stitches removed, the surgeon prescribed another course of antibiotics and some anti-inflammatories. I didn't fill those prescriptions either. My intent is not only to stay relatively functional through this process, but also to make sure that my bones heal well and are strong enough to allow me to continue doing what I've always done. I'm also hoping to be able to start putting some weight on my leg a fair bit earlier than the three to four months that the surgeon predicted.

Overall, I have to say that the biggest challenge for me has been not being able to walk the land. In my normal life, every day I take my dogs out for about an hour and a half and walk the trails through the fields and forest where I live. Aside from the obvious benefits of the exercise and fresh air for the dogs and myself, it provides me with an opportunity to deepen my ongoing relationship with the land; to observe what changes are taking place; to stop periodically at one or more of my favorite sit spots and just be. I'm also missing the winter. Last year was the warmest winter I can remember. There was pretty much no snow. This year we are having a somewhat more "normal" winter. I am missing walking through the snow; breathing the cold, crisp air; feeling the wind on my face; the calls of the chickadees, goldfinches and nuthatches. At best a couple of times a week when the conditions are good I can put the spiky snow things on the bottom of my crutches, go out and sit behind my house by our fire pit and gaze out over the landscape. I really do appreciate those moments.

"The Land" in winter.

Most of the details relating to the protocols that I am using have been covered in these first two parts of this series. From Part 3 of this series onwards I will discuss any changes that I make to these protocols and provide updates on how things are progressing.

Tuesday, February 12, 2013

Healing Bone Fractures, Part 1 of 5

Things have really slowed down in my life and I haven't been able to post anything for a few weeks. That's because on January 30th I badly broke my lower right leg! Even though I'm an outdoorsy kind of person, I figured if I made it this far in my life without breaking any bones, maybe I never will. Well, it turns out I was wrong!

The Niagara Escarpment along the east side of the Saugeen (Bruce) Peninsula not far from where we were hiking.

We were hiking along a trail near the Niagara Escarpment on the Saugeen (Bruce) Peninsula. This area is characterized by lots of dolomite rock outcroppings. Normally we would have been snowshoeing, but we got a couple of days of unseasonably warm weather and it rained a lot. The amount of snow went from 45 cm (1.5 feet) down to about 5 cm (2 inches), making it much more easy to walk in boots. While we were hiking, I stepped with my left foot into a crevice in the rock that I couldn't see because it was covered in snow. It was quite deep. I never hit bottom and all of my weight came down on my right shin on the rock. I have a clean break in my fibula just below my knee, but my tibia was shattered just above my ankle. I'll spare you the details of how we got out of there, but it was quite a trip! Had there still been enough snow to snowshoe, my foot wouldn't have fit into that crevice.

This is more like the terrain where we were hiking (and the right season!).

Because of the severity of the fracture, I needed surgery. They weren't able to get me into surgery until the following day. The injury occurred around noon on the 30th and I didn't get into surgery until around 4:30 pm on the 31st. I had to have a 25 cm (10 inch) plate screwed into my tibia to hold the pieces together. I have no cast because I need to be able to move and stretch the tendons and ligaments in my ankle and knee so they don't tighten up too much while I'm off my leg.

Here are a couple of x-ray views of my leg with the plate taken the morning after my surgery.
It's a pretty messy affair and I suspect that I will need to have surgery again at some point to remove it.

According to the surgeon, this kind of fracture takes about four months to heal. If I'm lucky, three months at the absolute minimum. During this time my leg can't bear any weight. Once it is strong enough to bear weight, I will require a month or two of physiotherapy to get the strength back in my leg. So, he's predicting that this process is going to take 4-6 months.

What the surgeon doesn't know, because it's outside his paradigm, is that I have tools available to me to accelerate the healing of my leg. I have a basic protocol for treating bone fractures that I have used to help heal other people. This is the first time I'm going to be using it on myself!

I am going to use this as an opportunity to provide an example of how to heal a bone fracture. I will provide details of exactly how I am treating this on an ongoing basis, and updates as to how my healing is progressing. The important thing to keep in mind is, although I am following a basic protocol, it needs to be fine-tuned for each specific situation. If four different people came to me with similar fractures, I would treat each person slightly different depending on their specific needs, constitution, history, etc. What I am describing is how I have adapted this protocol to my own specific needs. Nevertheless, it will provide a good example of how I treat this kind of injury.

The protocol that I use is very complex. It requires five different components all of which are important: herbal treatment, both systemic and local; homeopathic treatment; supplements that help our body heal tissue damage and rebuild bone tissue; physical therapy; and dietary adjustments to support the healing of this type of injury.

I am going to begin by providing details of what I used in the interim when I didn't have everything available to me to complete the protocol. Then I will document what I am using and my progress in a continuing series of posts.

In the early evening on the day of the fracture, when it became apparent that the surgery wasn't going to happen that day, I had myself checked out and we went back to the cottage we were renting where I knew I would be more comfortable and be able to eat some good food and make use of whatever herbs and supplements I had on hand. My partner, Monika, tried to find some of the additional remedies I needed but was only able to obtain homeopathic Arnica in a 30C potency. Homeopathic Arnica is an essential remedy for any kind of sudden traumatic injury. It reduces swelling, bruising and pain, and supports the healing process. While we were still there and through the evening I took it every hour. I didn't sleep very well and took it every couple of hours through the night as well, and continued taking it every hour the next day up until my surgery. I resumed it when I awoke on Friday.

Mountain arnica (Arnica montana) is mostly used topically by herbalists because it is very irritating and mildly toxic when taken systemically.
It should only be used systemically by experienced herbalists. In homeopathic potencies this is not an issue.

Homeopaths rarely use homeopathic remedies in combination with other modalities. Although I am not a homeopath, I have a good understanding of the system and sometimes use homeopathic remedies in combination with herbs, especially for the treatment of acute conditions. In order to treat a situation holistically, I have found that it is best if we address it on as many different levels and in as many different ways as possible. The more severe the injury or illness, the more important it is to do this.

At the cottage I also had available to me a general herbal tonic formulation containing 1:5 fresh herb tinctures that provided some benefit in terms of reducing inflammation and pain, increasing circulation and supporting the healing process. It also contained some liver herbs that would help protect me from the side-effects of all the medications I was going to have to take before and after the surgery. I upped the dose from 3 ml into the acute dosage range at 6 ml. Because I was going to have to fast the following day before my surgery, I only had one dose before my dinner, but I resumed it as soon as I returned from the hospital after my surgery. I also had some supplements including vitamins C (calcium ascorbate), D and E, zinc, polyphenols, and a good quality low potency multivitamin with a very good trace mineral complex. I took one of everything and two vitamin C with my dinner, and resumed these when I returned after my surgery as well. The last thing I had is a herbal sedative which I travel with because sometimes I have difficulty sleeping when I'm in an unfamiliar environment. I took this before bed and a couple more doses through the night. I didn't sleep very well that night, mostly because I had to sleep on my back which I never do, but it did help me sleep a bit and reduce the pain and inflammation.

Up to this point, except for the insane pain when I actually broke my leg, as long as my leg didn't get banged or twisted the pain wasn't that bad. The Arnica was definitely a factor in this.

After the surgery, the doctor wanted me to stay another night to make sure I didn't end up with a kind of serious swelling that can occur with this kind of injury, or an infection, and that my pain was under control. However, I was determined to get out of there as quickly as possible so that I could get onto the remedies that I needed. I stopped dosing myself with the intravenous hydromorphone (a semi-synthetic derivative of morphine) as soon as I woke up so that they would see that I was managing the pain and asked to be disconnected from everything. The surgeon saw I was doing OK and I managed to get out by 1 pm. He gave me a prescription for a drug containing 300 mg of acetaminophen and 30 mg of codeine phosphate. I didn't fill the prescription. We did pick up a product containing 500 mg of acetaminophen without the codeine. I took one tablet on Friday evening shortly before bed when the pain in my leg got pretty intense for a few hours. That was all I used.

It is important to note that we should not use non-steroidal anti-inflammatory drugs (NSAIDs), such as acetylsalicylic acid, ibuprofen and naproxen, to treat the pain and inflammation associated with bone fractures as these drugs interfere with bone formation. Drinking alcohol also interferes somewhat with bone formation. This is mainly a concern for moderate to heavy drinkers, nevertheless, it is best drink very little or not at all. Smoking has a more pronounced negative impact on bone formation than alcohol.

We went back to the cottage and stayed for the next three days. Some friends were coming up for the weekend and we asked them to bring me some additional homeopathic remedies. At this point my interim protocol was as follows:

Homeopathics: Arnica 200C, Hypericum 200C and Symphytum 200C taken individually, four pellets per dose alternated throughout the day every 1-2 hours so that I was taking each remedy 4 times per day. Hypericum is a specific for nerve damage and nerve pain. Although I did not have any numbness or tingling, indicating that there probably wasn't any nerve damage from the original injury, there was a risk of nerve damage resulting from the surgery. Symphytum is a specific for healing bones. I tend to use Hypericum and Symphytum both in homeopathic form and in crude tincture form as you will see later. The two forms taken together are very synergistic, working much better than either the tincture or homeopathic individually.

Common comfrey (Symphytum officinale) is a specific for bone fractures, both in herbal and homeopathic forms.
Crude herb preparations must be used carefully as it contains pyrrolizidine alkaloids, which are liver toxins.
This is not an issue when taken in homeopathic potencies.

Herbs: I continued taking the tincture formulation I had with me at a higher dose until I was able to get home and formulate something specific for my injury. I took 6 ml in a bit of water on an empty stomach 10-15 minutes before each meal. I also continued to take the sedative formulation, 6 ml before bed and additional 3 ml doses through the night, if necessary.

Supplements: Making the best use of the supplements that I had available, I took the following (these are the doses of the nutrients that are particularly important for bone repair as provided by the individual products I had available to me):
  • With breakfast: Vitamin A 3,500 IU, beta-carotene 7,500 mg, vitamin C 1,325 mg (from calcium ascorbate), vitamin D2 200 IU, vitamin D3 1,000 IU, vitamin K1 50 mcg, vitamin K2 10 mcg, calcium 152 mg (ascorbate), copper 0.5 mg (citrate), manganese 0.5 mg (citrate), zinc 5 mg (citrate), selenium 50 mcg (chelate), boron 0.35 mg (chelate), lutein 0.5 mg, bioflavonoids 100 mg (citrus extract), quercetin 100 mg, anthocyanidin 100 mg (mixed berry extract).
  • With lunch: Vitamin C 1,200 mg (from calcium ascorbate), vitamin D3 1,000 IU, calcium 137 mg (ascorbate), quercetin 100 mg, anthocyanidin 100 mg (mixed berry extract).
  • With dinner: Vitamin A 3,500 IU, beta-carotene 7,500 mg, vitamin C 1,325 mg (from calcium ascorbate), vitamin D2 200 IU, vitamin D3 1,000 IU, vitamin E 200 IU (mixed tocopherols), vitamin K1 50 mcg, vitamin K2 10 mcg, calcium 152 mg (ascorbate), copper 0.5 mg (citrate), manganese 0.5 mg (citrate), zinc 20 mg (citrate), selenium 50 mcg (chelate), boron 0.35 mg (chelate), lutein 0.5 mg, bioflavonoids 100 mg (citrus extract), quercetin 100 mg, anthocyanidin 100 mg (mixed berry extract).
Some of these are ingredients from a multivitamin that I took with breakfast and dinner. It is a good quality low potency multi with an excellent trace mineral content. It does not contain iron, calcium or magnesium because iron should only be taken when absolutely necessary and the amount of calcium and magnesium that can be included in a multivitamin is too low to be relevant. I did not list all of the ingredients of the multivitamin, only those that are important for bone repair. However, the full range of nutrients in the multi are important to support healing in general. In addition, I was also taking omega-3 fatty acids in the form of organic flax seed oil, 2-3 teaspoons taken throughout the day mixed in food (but not heated).

Other: From the moment I was able to stand after my injury I spent a lot of time wiggling my toes to help with circulation and to keep my feet as flexible as possible. Most other forms of movement were not possible until a few days after my surgery due to the severe swelling of my leg. Whenever I was sitting (always with my leg up to reduce swelling), a periodically massaged my knee and lower thigh to help prevent them from tightening up as much as possible. I was also doing deep breathing exercises in which I focused on "feeling" the life force energy or qi circulating through my body, particularly in my leg.

This is the end of my first post on the ongoing saga of my leg. In Part 2 I will provide the details of the complete protocol that I put myself on once I returned home.